Conversion Disorder; an unusual etiology of wrist drop: Report of a case and review of literature

Abstract

Wrist drop is commonly a consequence of Radial Nerve injury and infrequently due to C7/C8 radiculopathy, brachial plexus lesion or central causes. We present here a rare case of wrist drop due to conversion disorder. He was a 31-year-old soldier who presented with left sided wrist drop and numbness over dorsal aspect of left hand following gunshot injury to the left forearm. His repeated electrophysiological evaluation revealed injury to the sensory branch of left Radial Nerve. Magnetic resonance imaging of brain, muscle enzymes and routine laboratory investigations were normal. After getting treatment as a case of radial nerve injury, focal dystonia and adjustment disorder he was finally diagnosed as a case of conversion disorder. Motor point blocks, orthotic support, electrical muscle stimulation, cognitive behavioral therapy and biofeedback were tried but did not prove effective. Patient ultimately landed up with the psychiatrist and is still under his treatment. Conversion disorder may be considered in a patient presenting with wrist drop when no organic cause can be found. Early opinion of a psychiatrist is needed to be sought in suspicious cases after providing relevant clinical findings and investigations.